Facilitators and Barriers to Linkage to HIV Care and Treatment among Female Sex Workers in a Community-based HIV Prevention Intervention in Tanzania: a qualitative study

AbstractBackgroundHIV-infected female sex workers (FSWs) have poor linkage to HIV care in sub-Sahara Africa.MethodsWe conducted 21 focus group discussions (FGDs) to explore factors influencing linkage to HIV care among FSWs tested for HIV through a comprehensive community-based HIV prevention project in Tanzania.ResultsInfluences on linkage to care were present at the system, societal and individual levels. System-level factors included unfriendly service delivery environment, including lengthy pre-enrolment sessions, concerns about confidentiality, stigmatising attitudes of health providers. Societal-level factors included myths and misconceptions about ART and stigma. On the individual level, most notable was fear of not being able to continue to have a livelihood if one’s status were to be known. Facilitators were noted, including the availability of transport to services, friendly health care providers and peer-support referral and networks.ConclusionFindings of this study underscore the importance of peer-supported linkages to HIV care and the need for respectful, high-quality care.

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Facilitators and barriers to linkage to HIV care and treatment among female sex workers in a community-based HIV prevention intervention in Tanzania: A qualitative study

PLoS ONE ◽

10.1371/journal.pone.0219032 ◽

2019 ◽

Vol 14 (11) ◽

pp. e0219032 ◽

Cited By ~ 2

Author(s):

Daniel Nyato ◽

Soori Nnko ◽

Albert Komba ◽

Evodius Kuringe ◽

Marya Plotkin ◽

...

Keyword(s):

Hiv Prevention ◽

Qualitative Study ◽

Sex Workers ◽

Female Sex Workers ◽

Hiv Care ◽

Community Based ◽

Prevention Intervention ◽

Hiv Prevention Intervention ◽

Facilitators And Barriers ◽

Linkage To Hiv Care

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A Qualitative Exploration of Family, Work, Community, and Health Service Influences on HIV Treatment Uptake and Adherence Among Female Sex Workers in Three Cities in Indonesia

AIDS Education and Prevention ◽

10.1521/aeap.2020.32.3.243 ◽

2020 ◽

Vol 32 (3) ◽

pp. 243-259

Author(s):

Elke Mitchell ◽

Elan Lazuardi ◽

Irma Anintya ◽

Emily Rowe ◽

Kate Whitford ◽

...

Keyword(s):

Support Groups ◽

Sex Workers ◽

Female Sex Workers ◽

Treatment Initiation ◽

Geographical Location ◽

Hiv Treatment ◽

Hiv Care ◽

Community Based ◽

Female Sex ◽

Outreach Workers

Qualitative data were collected from 34 Indonesian female sex workers to understand their engagement with HIV treatment. Influences that enhanced treatment initiation and adherence included women's desires to stay healthy to continue working to provide for families; awareness of the biomedical benefits of treatment; support from bosses, outreach workers, and peer support groups; and flexible, nonjudgmental HIV service provision. Influences inhibiting treatment initiation and adherence included concerns about unwanted disclosure in the workplace and side effects of medication on women's capacity to earn money through sex work; geographical location of services; discrimination and confidentiality concerns in HIV care services. To improve HIV treatment initiation and adherence among Indonesian female sex workers, future responses should explore health promotion messages that engage with women's family and livelihood obligations; increased funding for community-based peer outreach workers; community-based treatment initiation and supply; and advocacy in work environments to secure support for treatment initiatives.

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Exploring peer navigation and support in the quality of HIV care experiences of female sex workers in the Dominican Republic

BMC Health Services Research ◽

10.1186/s12913-021-07439-4 ◽

2022 ◽

Vol 22 (1) ◽

Author(s):

Tahilin Sanchez Karver ◽

Clare Barrington ◽

Yeycy Donastorg ◽

Martha Perez ◽

Hoisex Gomez ◽

...

Keyword(s):

Dominican Republic ◽

Sex Workers ◽

Female Sex Workers ◽

Hiv Treatment ◽

Hiv Care ◽

Care Providers ◽

Female Sex ◽

Care Services ◽

Peer Navigation

Abstract Background Despite evidence on peer navigation’s association with positive HIV outcomes, such as engagement in HIV care and antiretroviral therapy (ART) initiation, the mechanisms through which peer navigation may influence these outcomes have been less explored. The purpose of this study is to describe the role of peer navigation and support on enhancing the quality of HIV treatment and care services experienced by female sex workers (FSWs). Methods Survey data was derived from a quantitative cohort (n = 211) of FSWs living with HIV in the Dominican Republic and complemented with data from two rounds of in-depth interviews (IDIs) from a qualitative subsample (n = 20 per round). Descriptive statistics and multivariable logistic regressions were used to explore the association between peer navigation and relational aspects of care and overall satisfaction of the quality of HIV treatment and care. Thematic analysis was employed to code and synthesize textual data from IDIs. Results 41.2% of the participants reported having had contact with a peer navigator in the last 6 months. Qualitative data revealed that peer navigation and support was instrumental in assisting FSWs linkage to HIV care after diagnosis, elevating FSWs’ ability to access more comprehensive clinical care facilities, and promoting agency by improving FSWs’ skills to more strategically and effectively engage with the clinic environment and health care providers. Peer navigation was positively associated with experiencing more respectful treatment by clinic staff (AOR: 6.65, 95% CI: 2.32–19.02), and greater satisfaction with overall HIV care services (AOR: 2.57, 95% CI: 1.77–3.74). Conclusion Promoting the full integration of peer navigation into healthcare structures is a strategic approach to enhance the quality of HIV care experienced by FSWs and improve their HIV-related outcomes.

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Facilitators and Barriers to Linkage to HIV Care among Female Sex Workers Receiving HIV Testing Services at a Community-Based Organization in Periurban Uganda: A Qualitative Study

Journal of Sexually Transmitted Diseases ◽

10.1155/2016/7673014 ◽

2016 ◽

Vol 2016 ◽

pp. 1-8 ◽

Cited By ~ 9

Author(s):

Sharon Nakanwagi ◽

Joseph K. B. Matovu ◽

Betty N. Kintu ◽

Frank Kaharuza ◽

Rhoda K. Wanyenze

Keyword(s):

Qualitative Study ◽

Peer Support ◽

Sex Workers ◽

Female Sex Workers ◽

Hiv Care ◽

Community Based ◽

Community Based Organization ◽

Hiv Testing Services ◽

Facilitators And Barriers ◽

Linkage To Hiv Care

Introduction. While four in ten female sex workers (FSWs) in sub-Saharan Africa are infected with HIV, only a small proportion is enrolled in HIV care. We explored facilitators and barriers to linkage to HIV care among FSWs receiving HIV testing services at a community-based organization in periurban Uganda. Methods. The cross-sectional qualitative study was conducted among 28 HIV positive FSWs from May to July 2014. Key informant interviews were conducted with five project staff and eleven peer educators. Data were collected on facilitators for and barriers to linkage to HIV care and manually analyzed following a thematic framework approach. Results. Facilitators for linkage to HIV care included the perceived good quality of health services with same-day results and immediate initiation of treatment, community peer support systems, individual’s need to remain healthy, and having alternative sources of income. Linkage barriers included perceived stigma, fear to be seen at outreach HIV clinics, fear and myths about antiretroviral therapy, lack of time to attend clinic, and financial constraints. Conclusion. Linkage to HIV care among FSWs is influenced by good quality friendly services and peer support. HIV service delivery programs for FSWs should focus on enhancing these and dealing with barriers stemming from stigma and misinformation.

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Successful integration of HIV pre-exposure prophylaxis into a community-based HIV prevention program for female sex workers in Kolkata, India

International Journal of STD & AIDS ◽

10.1177/0956462420983992 ◽

2021 ◽

Vol 32 (7) ◽

pp. 638-647

Author(s):

Smarajit Jana ◽

Protim Ray ◽

Soma Roy ◽

Abhijit Kadam ◽

Raman R Gangakhedkar ◽

...

Keyword(s):

Hiv Prevention ◽

Sex Workers ◽

Prevention Program ◽

Female Sex Workers ◽

Community Support ◽

Final Visit ◽

Community Based ◽

Female Sex ◽

Exposure Prophylaxis ◽

The Impact

We assessed the impact of pre-exposure prophylaxis (PrEP) in the context of a community-based HIV program among female sex workers (FSWs) in Kolkata, India. This was an open-label, uncontrolled demonstration trial. HIV seronegative FSWs over 18 years were eligible. Participants were administered daily tenofovir/emtricitabine (TDF-FTC) with follow-up visits at months 1, 3, 6, 9, 12, and 15. Drug adherence was monitored by self-report, and a random subset of participants underwent plasma TDF testing. 843 women were screened and 678 enrolled and started on PrEP. Seventy-nine women (11%) did not complete all scheduled visits: four women died of reasons unrelated to PrEP and 75 withdrew, for a 15-month retention rate of 89%. Self-reported daily adherence was over 70%. Among those tested for TDF, the percentage of women whose level reached ≥40 ng/mL was 65% by their final visit. There were no HIV seroconversions, and no evidence of significant changes in sexual behavior. This study demonstrated the feasibility and effectiveness of PrEP for FSWs in Kolkata, with very high levels of adherence to PrEP and no HIV seroconversions. The integration of PrEP into an existing community-based HIV prevention program ensured community support and facilitated adherence.

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HIV/AIDS Preventive Practice and Associated Factors among Female Sex Workers in Afar Region, Ethiopia: A Community Based Study

Ethiopian Journal of Health Sciences ◽

10.4314/ejhs.v30i1.7 ◽

2020 ◽

Vol 30 (1) ◽

Author(s):

Abay Woday Tadesse ◽

Wossen Chernet ◽

Osman Ahmed ◽

Woldemichael Tadesse

Keyword(s):

Logistic Regression ◽

Hiv Prevention ◽

Sex Workers ◽

Associated Factors ◽

Female Sex Workers ◽

Community Based ◽

Preventive Practice ◽

Female Sex ◽

Afar Region ◽

Hiv Aids

BACKGROUND: Female Sex Workers (FSWs) are a high-risk population for Human Immune Virus (HIV) infection. However, HIV related services for sex workers are given little attention in developing nations like Ethiopia. Thus, this study attempted to assess HIV preventive practice and associated factors among FSWs in the Afar region.METHODS: Community-based cross-sectional study was conducted on 419 FSWs from April 1st to May 2nd in 2018 in four hotspot towns (i.e. Logia, Mille, Gedamayitu and Awash) found in Afar region. The study participants were selected using snowball sampling technique. The sociodemographic and behavioral data were collected using face-toface interview. Logistic regression analyses were done to determine factors associated with HIV prevention practices. The statistically significant level was declared at a P-value < 0.05.RESULTS: The HIV/AIDS preventive practice among FSWs was 61.1% [95% CI 56.2% - 65.9%]. The multivariable logistic regression analysis showed that being single [AOR=2.57: 95% CI 1.06, 6.21:P<0.05] and urban residence before being FSWs [AOR= 3.26: 95% CI 1.25, 8.54: P<0.05] were found to be enhancing factors of the preventive practice of HIV/AIDS. However, being illiterate [AOR=0.133: 95% CI 0.032, 0.557: P<0.01], young age [AOR=0.065: 95% CI 0.021, 0.196:P<0.001], being alcohol drinker [AOR= 0.104: 95% CI 0.026, 0.417: P<0.01], being cigarette smoker [AOR= 0.096: 95% CI 0.022, 0.414:P<0.01] and lack of aware of HIV transmission [AOR= 0.08: 95% CI0.03, 0.22: P<0.001] were the hindering factors of the preventive practice of HIV among FSWs.CONCLUSION: The HIV/AIDS preventive practice among FSWs in Afar region hotspot towns (61.1%) is still very low compared to the country progress report on HIV response for FSWs (98%). The regional health bureau should design inclusive strategies to improve the HIV preventive practice among FSWs. These includes regular HIV testing campaigns, sustainable condom distribution in the hotspot towns. The region should encourage NGOs to work on inclusive HIV prevention upon FSWs. Female sex workers should be aware of the risky behaviors that lead to HIV. Additional qualitative methods are also recommended.

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